Vaginal Health and Discomfort: Let’s Talk About It

The onset of vaginal dryness as a result of menopause, surgery, (removal of ovaries) or cancer treatments can destroy what was once a healthy, satisfying sex life. It’s not just about painful intercourse: these changes in the vaginal tissue can result in irritation, and urinary symptoms such as urgency and recurrent bladder infections. In spite of the fact that over 50 percent of post menopause women have vaginal issues significant enough to interfere with or put a screeching halt to intercourse and intimacy, studies show that the topic is rarely discussed in the doctor’s office.

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Lauren Streicher, MD, medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause, brings this taboo topic into the open and is letting women know that there are a number of solutions that will repair thin, damaged tissue and restore comfort. Using the options listed below and further outlined in her book, Sex Rx: Hormones, Health and Your Best Sex Ever, Dr. Streicher believes “women can turn sandpaper sex back into slippery sex.”

Lubricants Lubricants do not thicken or alter dry, thin vaginal tissues; they just provide a slippery coating to reduce friction at the time of intercourse. Water based lubricants are readily available and inexpensive, but can be sticky or irritating. Silicone lubricants, on the other hand, are more slippery, last much longer and are non-irritating.

Moisturizers A long-acting vaginal moisturizer, increases the water content inside the cells that line the vagina, resulting in tissue that is more elastic, thicker and better able to naturally produce lubrication. It is used in anticipation of intercourse, not at the time of intercourse. While many products call themselves “personal” moisturizers, most are actually lubricants and intended for use at the time of intercourse. Only one product, Replens, has been proven in scientific studies to thicken vaginal walls, increase lubrication and decrease painful intercourse.

Local Vaginal Estrogen Local vaginal estrogens are prescription products that are placed in the vagina on an ongoing basis to alleviate the symptoms of vaginal thinning. While some vaginal estrogen is absorbed into the bloodstream, the amount is minimal and its effects are local rather than systemic.

All vaginal estrogen products improve the thickness, elasticity and lubrication of your tissue. Personal preference, ease of use and convenience dictate which product you might choose. There are three options: Estrogen creams are inserted into the vagina twice weekly, a tiny estrogen vaginal tablet also requires twice weekly insertion and finally a disposable estrogen vaginal ring to be replaced every three months.

Ospemifene is a daily pill to be taken by mouth. This medication is not estrogen but is classified as a SERM, or selective estrogen receptor modulator. Ospemifene activates estrogen pathways in vaginal tissue and has essentially has the same effect as local vaginal estrogen.

CO2 Vaginal Laser While lubricants are helpful for some women, many women require additional treatment. Only 7 percent of affected women use one of the prescription products to alleviate symptoms beyond what a lubricant or a long acting moisturizer can treat.

Many women, despite reassurances, are concerned about side effects from local vaginal estrogen or are advised by their physicians to not use a local vaginal estrogen. Some women simply do not want to use a pharmaceutical product on a regular basis.

As a result, too many women either abandon sexual activity altogether, or put up with the pain. The Center for Sexual Medicine and Menopause (link) now offers a non-hormonal solution for women who prefer not to, or have been advised to avoid estrogen. The Mona Lisa Touch is a medical CO2 laser that stimulates both surface and deep layers of vulvar and vaginal tissue to produce collagen and promote blood flow. The result is restoration of vaginal lubrication and elasticity. Unlike other CO2 laser programs, we treat both vaginal (internal) and vulvar (external) tissue.

The treatment involves three painless, five-minute sessions performed in our office and spaced six weeks apart. No anesthesia other than a local anesthetic cream that is applied to the opening of the vagina and vulva is required and most women report only a gentle vibration while a slender laser probe is in the vagina.

If you're interested in CO2 vaginal laser treatments, please fill out the Mona Lisa Touch Pre-Screening Questionnaire. CO2 treatments generally require evaluation in the Center for Sexual Medicine and Menopause prior to scheduling your first treatment to ensure you are a candidate. The Mona Lisa Touch treatment is not covered by insurance. For pricing and more information, please call 312.472.0502